title: Usefulness of 64Cu-ATSM in head and neck cancer: a preliminary prospective study.
abstract: OBJECTIVE
  Cu-diacetyl-bis(N4-methylthiosemicarbazone) (Cu-ATSM) is a hypoxia-avid, positron emitter radiotracer. The primary aim of this study is to assess the efficacy of pretherapy Cu-ATSM PET/CT as a prognostic factor of response to therapy. The secondary aims are to investigate if there is a difference between early and late PET/CT scans and if there is a difference between the biologic tumor volume (BTV) in radiotherapy treatment planning calculated between Cu-ATSM and F-FDG, and to assess if Cu-ATSM is a prognostic marker of disease progression.
  
  
  METHODS
  Eleven patients with head and neck cancer treated with chemoradiotherapy were enrolled prospectively; both Cu-ATSM and F-FDG PET/CT scans before and after treatment were obtained. The Cu-ATSM scans were performed after 1 hour (early) and 16 hours (late).
  
  
  RESULTS
  All patients had stage III or IV squamous cell head and neck cancer; 7 of 11 patients had nodal metastasis, and 22 cancer foci were detected with Cu-ATSM. SUVmax was 16.2 ± 7.9, and there was no significant SUVmax difference between early and late imaging. F-FDG SUVmax before therapy was 15.6 ± 9.4, whereas F-FDG SUVmax after therapy was 1.5 ± 1.2. Sensitivity and specificity values of Cu-ATSM calculated with receiver operating characteristic curves were 100% and 50% considering the SUVmax and 100% and 33% considering the volume, respectively. No difference has been found between the BTV contoured with Cu-ATSM and F-FDG.
  
  
  CONCLUSIONS
  The Cu-ATSM scans showed high sensitivity but low specificity in predicting neoadjuvant chemoradiotherapy response. No difference was noted between early and late scans. F-FDG and Cu-ATSM provided similar results about delineation of BTV.
authors.affiliation: From the Departments of *Nuclear Medicine, †Medical Physics, and ‡Radiotherapy, Sant' Orsola-Malpighi Hospital, Bologna, Italy; §Department of Radiology, University of Southern California, Los Angeles, CA; and ¶Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Grassi
authors.forename: Cristina
authors.initials: C
authors.lastname: Nanni
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cicoria
authors.forename: Claudio
authors.initials: C
authors.lastname: Blasi
authors.forename: Feisal
authors.initials: F
authors.lastname: Bunkheila
authors.forename: Egesta
authors.initials: E
authors.lastname: Lopci
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Colletti
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
mesh_terms: D056831:Coordination Complexes; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009942:Organometallic Compounds; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D013882:Thiosemicarbazones; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D056831:Coordination Complexes; D009942:Organometallic Compounds; D013882:Thiosemicarbazones; C089548:copper (II) diacetyl-di(N(4)-methylthiosemicarbazone)